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Medication Review

Important Points about Medication Review

The use of drugs in patients with reduced renal function can give rise to problems for several reasons:

  • failure to excrete a drug or its metabolites may produce toxicity;
  • sensitivity to some drugs is increased even if elimination is unimpaired;
  • many side-effects are tolerated poorly by patients in renal failure;
  • some drugs cease to be effective when renal function is reduced.
  • some drugs require dose reduction when renal function is reduced e.g. digoxin, allopurinol

ACEi and ARBs - always beware of rising potassium and falling eGFR, especially when taking both together or with Spironolactone or NSAIDS

NSAIDs - avoid if possible, if not then use lowest effective dose. They will directly antagonise diuretics and antihypertensives.

Spironolactone - beware high potassium especially with ACEi or ARBs

Metformin - suggest avoid if eGFR < 50

Antibiotics - avoid Nitrofurantoin, all tetracyclines except doxycycline / minocylcine